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Monosomal karyotype is associated with poor outcomes in patients with Philadelphia chromosome–negative acute lymphoblastic leukemia receiving chemotherapy but not allogeneic hematopoietic stem cell transplantation

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Abstract

Monosomal karyotype (MK) is associated with poor prognosis in patients with myeloid neoplasms; however, its prognostic significance in Philadelphia chromosome–negative (Ph-negative) acute lymphoblastic leukemia (ALL) remains unclear. Data of 323 patients with Ph-negative ALL treated at Peking University People’s Hospital were retrospectively analyzed. MK was identified in 49 (14.8%) patients. The patients with MK had lower hemoglobin levels (P = 0.026), lower platelet count (P = 0.032), higher percentages of blasts in the peripheral blood at diagnosis (P = 0.008), and higher percentages of high-risk karyotypes (P < 0.001) compared with those without MK. The complete remission (CR) rate and the minimal residual disease negativity rate were not significantly different between patients with and without MK. In the multivariate analysis, MK was identified as an independent factor associated with higher cumulative incidence of relapse (CIR) (hazard ratio (HR), 2.07; 95% confidence interval (CI), 1.02, 4.21; P = 0.043), shorter disease-free survival (DFS) (HR, 2.80; 95% CI, 1.20, 6.54; P = 0.017) and shorter overall survival (OS) (HR, 5.75; 95% CI, 2.07, 16.03; P = 0.001) in the chemotherapy cohort; however, MK had no impact on outcomes in the allogeneic hematopoietic stem cell transplantation (allo-HSCT) cohort. Mantel-Byar analysis showed that allo-HSCT was associated with lower CIR (P < 0.001), longer DFS (P < 0.001), and longer OS (P < 0.001) in CR patients with MK. In conclusion, our study showed that MK was an independent predictor of poor outcomes in patients with Ph-negative ALL receiving chemotherapy but not allo-HSCT, and allo-HSCT could improve the outcomes of patients with MK.

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Acknowledgments

We thank all the patients involved in this study and every faculty member of Peking University Institute of Hematology who participated in this study. We also thank American Journal Experts (www.journalexperts.com) for providing editorial assistance.

Funding

This study was funded by the National Natural Science Foundation of China (grant no. 81770161).

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  1. Zongru Li and Yueyun Lai contributed equally to this work.

Authors and Affiliations

  1. Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People’s Republic of China

    Zongru Li, Yueyun Lai, Xiaohui Zhang, Lanping Xu, Kaiyan Liu, Yu Wang, Chenhua Yan, Hao Jiang, Xiaojun Huang & Qian Jiang

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  1. Zongru Li
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  2. Yueyun Lai
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Contributions

Conception/design: Qian Jiang and Xiaojun Huang. Treated patients: Xiaohui Zhang, Lanping Xu, Kaiyan Liu, Yu Wang, Chenhua Yan, Hao Jiang, Xiaojun Huang, and Qian Jiang. Cytogenetic karyotype analysis and classification: Yueyun Lai. Collection and/or assembly of data: Zongru Li and Yueyun Lai. Data analysis and interpretation: Zongru Li and Qian Jiang. Manuscript writing: Zongru Li, Yueyun Lai, Xiaojun Huang, and Qian Jiang. Final approval of manuscript: All authors.

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Correspondence to Xiaojun Huang or Qian Jiang.

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The study protocol was approved by the ethics committee of Peking University People’s Hospital.

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Li, Z., Lai, Y., Zhang, X. et al. Monosomal karyotype is associated with poor outcomes in patients with Philadelphia chromosome–negative acute lymphoblastic leukemia receiving chemotherapy but not allogeneic hematopoietic stem cell transplantation. Ann Hematol 99, 1833–1843 (2020). https://doi.org/10.1007/s00277-020-04155-7

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